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An acquired brain injury, or ABI, is an injury after birth that is not hereditary, degenerative, or induced by birth trauma. When the head is hit or the brain is damaged, how the brain functions and communicates with the rest of the body may become changed. ABI is used as the umbrella definition for brain injury and can be further defined by how the injury is sustained: traumatic and non-traumatic.

Different parts of the brain are responsible for different functions a person can perform, such as a person’s movements, emotions, processing of the sounds/sights around, starting or holding a conversation, or being able to pay attention or remember information.

When the brain is injured, tasks may be more challenging than prior to injury. Repetitive training and strategies to help compensate for change in function can form new pathways within the brain to facilitate rehabilitation.

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Types of Brain Injury

Did you know that not all brain injuries are the same? Despite the make-up or changes in a person’s brain, people living with brain injury are people first – not a diagnosis or someone to be counted out.  The type of injury refers to the method of injury, not necessarily the changes that can occur.

Non-traumatic Brain Injury

caused by changes occurring inside of the body that may lead to more localized or specific damage to the brain.

Examples:

  • stroke
  • substance overdose
  • lack of oxygen
  • brain tumors

Traumatic Brain Injury (TBI)

result of forces outside the body - a bump, jolt, or blow to the head - that may lead to more generalized effects (or damaging multiple areas of the brain).

Examples:

  • falls
  • motor vehicle collisions
  • assaults
  • blasts
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Categories of TBI

Mild

Loss of consciousness lasting less than 30 minutes (or not at all), any alteration of consciousness, or no memory around the traumatic event (post-traumatic amnesia) lasting less than 24 hours. Glasgow Coma Scale score of 13 to 15.

Moderate & Severe

Loss of consciousness lasting more than 30 minutes to prolonged coma, post-traumatic amnesia lasting more than 24 hours (or permanently), and Glasgow Coma score as low as 3.

TBI By Numbers

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Changes after Brain Injury

PHYSICAL & SENSORY

(how your muscles or bodily health is affected)

  • seizures
  • fatigue & sleep disruption
  • headaches & pain
  • weakness or paralysis
  • movement & coordination
  • sexual function
  • balance
  • sensory changes (sight, smell, hearing, etc.)

THINKING & PROCESSING

(how you process and engage with your environment)

  • memory or recall
  • mental flexibility & learning
  • attention & concentration
  • initiation & motivation
  • task-switching & sequencing
  • mental fatigue
  • safety awareness & impulsivity
  • problem-solving & decisions
  • social skills & communication

EMOTIONS & BEHAVIOR

(how you feel & act that may be different than before)

  • difficulty with regulation (emotions or actions)
  • self-awareness
  • irritability or restlessness
  • unrelated laughter or crying
  • personality changes
  • lethargy or slowness
  • psychological conditions (depression, anxiety, etc.)
Changes after Brain Injury
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Science of TBI

Neurons are the communicating agents within the brain. All sensations, movements, thoughts, and feelings are a result of chemical signals (or neurotransmitters) produced between these cells. Neurons cannot communicate alone, however. Glial cells are like a warm blanket for the neurons, making neurons communicate at lightning speed. Recently scientists found out that glial cells are actually more in number than neurons in the brain. Therefore, if glial cells are affected through a brain injury, one’s processing speed may be compromised and neurons may not be nourished to thrive. Neurons and glial cells can be damage at the cellular level due to a lack of oxygen, excessive bleeding, swelling/pressure within the skull, or the tearing of neurons due to their long structure. The result can be chemical changes within the brain or functional changes affecting physical, cognitive, emotional, behavioral, and social capacities.

The brain is divided up into hemispheres and then lobes. Where the injury occurs within the brain can be reflective of the challenges and changes that occur afterwards. For example, the frontal lobe is responsible for concentration, planning, regulation, and organization. People after a frontal lobe injury may appear inattentive, have difficulty with initiation, or act impulsively. That is likely due to the connections that are affected within the brain.

Left Hemisphere

  • controls movement and sensation in the right side of the body
  • verbal and logical functions including language (listening, reading, speaking, and writing)
  • thought and memory involving words

Right Hemisphere

  • controls movement and sensation in the left side
  • nonverbal and intuitive functions such as putting bits of information together to make up an entire picture
  • recognizing oral and visual patterns and designs (music and art)
  • expressing and understanding emotions

Parts of the Brain

Frontal lobe Organization & regulation (attention, processing, decision-making, initiation, etc.)
Parietal lobe Integrating sensory information
Temporal lobe memory, language, hearing
Occipital lobe Visual processing
Brain Stem Arousal, Breathing, Heart rate
Motor & sensory cortex Movement and senses
Cerebellum Coordination & balance
Limbic system Fight or Flight, Reward Pathway, and Emotions

Just because a part of the brain may be injured, there is potential for physical and cognitive rehabilitation based on neuroplasticity – the brain’s capacity to change and adapt as the result of interactions with environment. This “re-wiring” of the brain can make it possible for an undamaged area to complete functions previously managed by a damaged area. For some, compensation strategies such as assistive technology, calendars, alarms, lists, and more can be helpful in completing daily tasks and helping with routines.

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Strategies for Success

Many changes after a brain injury are not seen on the outside but can be all-consuming on the inside. Sometimes stigma or assumptions about people living with brain injury can affect independence or how someone engages in their community. Developing strategies as well as empowering yourself and others are key for living well after injury. Though it may feel like a long process, growth and change after brain injury can be possible with patience, flexibility, and when even the small victories are celebrated.

Create structure & keep routines with scheduled breaks

  • Minimize distractions/clutter and break tasks, goals, or instructions into smaller, realistic ones.
  • Consistency & a schedule can help with memory and reducing confusion.

Practice creativity and flexibility in rehabilitation

  • Make opportunities out of every activity or chore into practicing a skill.
  • Use repetition, rephrasing, and cueing while providing written, accessible handouts.

Connect with resources & people

  • Prevent any feeling of isolation by linking with supports in the area or online.
  • Identify what you need with self-care to prevent burnout, fatigue, and frustration.

Educate, then advocate

  • Educate yourself and others on brain injury to advocate for your needs and services.
  • Look online for resources, events, education, committees, and more.

Try, adapt, and modify - Every person is different

  • Use planners, labeling, color-coded systems, notebooks, Smartphone apps, communication books, etc. to help with everyday tasks.
  • If something doesn't work or fit, brainstorm ways to modify it for the person.
  • Seek out independent living or employment specialists for assistive technology or tools.

Be proactive in solving problems & plan ahead

  • Offer or ask for on-the-spot, specific feedback (what do you want vs. do not).
  • Create plans or develop alternative strategies for escalating mood/behavior.
  • Investigate behaviors for what they are trying to communicate (a need, safety, or discomfort).
strategies for success

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